This effectiveness trial assesses a set of asthma tools designed to provide primary care practices with simple, easily implemented methods to 1. Track and report current care and care improvements, 2. Monitor patient symptoms, trigger avoidance, level of adherence and 3. Guide care using a linked algorithm for management (not just drug therapy). The specific aims are to assess the impact of the tools compared to usual care to: 1. improve patient-oriented and practice process outcomes for asthma care; 2. and maintain the improvements over 2 years. In addition, we will 3. Explore facilitators and barriers of implementing the Asthma APGAR tools within and across family medicine practices. The Asthma APGAR tools were developed and initially validated in rural primary care practices with R03 funding from AHRQ and a small grant from the AAFP Foundation. When implemented in rural family medicine practices the Asthma APGAR tools have been shown to change the content of asthma care, modify physician prescribing patterns and increase patient satisfaction with asthma care. This study takes the next step of assessing the ability of the tools to improve patient outcomes and practice efficiency. The Asthma APGAR tools address five domains critical to the tracking, assessment, monitoring and management of asthma.(See Table 1) The tools include a simple practice asthma care audit to motivate, monitor and report asthma care change; a patient-completed survey to be used at all asthma visits to monitor control and address the most common reasons for lack of control and finally a care algorithm that is based on the 2007 national asthma guideline's STEP therapy but incorporates non-drug management items such as asthma education, asthma action plans and inhaler technique evaluation. This clinical trial will focus on smaller practices and incorporates a simplified change process to implement, and sustain systematic use of the Asthma APGAR tools within these smaller, rural practices that should lead to more guideline adherent asthma care and improved patient outcomes. In addition to assessing the traditional quantitative outcomes of a clinical trial, we will use qualitative methods to explore the factors that are associated with the ability and feasibility of implementing the Asthma APGAR tools and facilitate practice change within and across practices. The project uses an innovative set of tools and an innovative approach to practice change that embeds guided self-motivation as the first step in practice change. Table 1- APGAR domains A---Activity limitation P---Persistence of symptoms Day and night G---TriGger identification A---Adherence to medications R---Response to therapy